Prenatal care is a key strategy to reduce maternal and perinatal morbidity and mortality, yet important regional inequities persist in Brazil. The ratio between the number of prenatal consultations and live births (PN/NV) is a synthetic indicator of coverage and intensity of gestational follow-up.To analyse the ratio between the number of prenatal consultations and the number of live births in Brazil from 2008 to 2023 by macro-region.Ecological time-series and spatial study using secondary data aggregated by federative unit and region. Annual numbers of live births were obtained from the Live Birth Information System and prenatal consultations from the Outpatient Information System of the Unified National Health System. We calculated the PN/NV ratio for each federative unit and year and built choropleth maps for 2008, 2011, 2014, 2017, 2020 and 2023. For 2024, we described the distribution of consultations by professional category based on Brazilian Occupational Classification codes. Analyses were descriptive.The PN/NV ratio increased in all regions until the mid-2010s, followed by relative stability and a marked decline in 2020, with partial recovery by 2023. Throughout the series, South and Southeast showed the highest ratios, while North and Northeast remained below the national average and were more affected during the COVID-19 pandemic. In 2024, nurses accounted for 46.3% of prenatal consultations in Brazil, reaching 68.0% in the Northeast and 61.3% in the North; general practitioners and family physicians performed 27.5% of visits, predominating in the Centre-West (39.8%) and South (34.7%); and maternal-child and gynaecology-obstetrics specialists were responsible for 26.1% of consultations, mainly in the Southeast (45.9%).The combination of PN/NV ratios and spatial analysis highlighted a persistent pattern of regional inequality in prenatal care intensity, exacerbated but not created by the pandemic and linked to unequal distribution of services and workforce.Despite advances in prenatal coverage, Brazil still exhibits marked spatial and professional disparities. Strengthening primary care in vulnerable territories and valuing the nursing workforce are essential to ensure more equitable and continuous prenatal care.